Torrent-Colomer, AnnaAmengual, JoanaSampol, CatalinaRuiz, MarioRioja, JorgeMatheu, GabrielRoca, PilarCórdoba, Octavi2024-10-042024-10-042022-02Torrent A, Amengual J, Sampol CM, Ruiz M, Rioja J, Matheu G, et al. Sentinel Lymph Node Biopsy in Endometrial Cancer: Dual Injection, Dual Tracer-A Multidisciplinary Exhaustive Approach to Nodal Staging. Cancers. 2022 Feb;14(4):929.https://hdl.handle.net/20.500.13003/19814https://hdl.handle.net/20.500.12105/23517Introduction: Sentinel lymph node (SLN) has recently been introduced as a standard staging technique in endometrial cancer (EC). There are some issues regarding team experience and para-aortic detection. Objective: to report the accuracy of SLN detection in EC with a dual tracer (ICG and Tc99) and dual injection site (cervix and fundus) during the learning curve. Methods: A prospective, observational single-center trial including 48 patients diagnosed with early-stage EC. Dual intracervical tracer (Tc99 and ICG) was injected at different times. High-risk patients had a second fundus injection with both tracers. Results: the detection rates were as follows: 100% (48/48) overall for SLNs; 98% (47/48) overall for pelvic SLNs; 89.5% (43/48) for bilateral SLNs; and 2% (1/48) for isolated para-aortic SLNs. In high-risk patients, the para-aortic overall DR was 66.7% (22/33); 60.7% (17/28) with ICG and 51.5% (17/33) with Tc99 (p = 0.048)). Overall rate of lymph node involvement was 14.6% (7/48). Macroscopic pelvic metastasis was found in four patients (8.3%) and microscopic in one case (2%). No metastasis was found in any para-aortic SLNs. Half of the patients with positive pelvic SLNs had positive para-aortic nodes. In high-risk patients, when para-aortic SLNs mapped failed, 36.4% (4/11) had positive nodes in para-aortic lymphadenectomy. The sensitivity and negative predictive value (NPV) of SLN pelvic detection was 100%. Conclusions: Multidisciplinary exhaustive approach gives a suitable accuracy of SLN during learning curve. Dual injection (cervical and fundal) with dual tracer (ICG and Tc99) offers good overall detection rates and increases para-aortic SLN detection.enghttp://creativecommons.org/licenses/by/4.0/Endometrial cancerSentinel lymph nodeLearning curveIndocyanine greenRadiotracerLymphatic mappingresearch articleAttribution 4.0 International3520567614492910.3390/cancers140409292072-6694Cancersopen access2-s2.0-85124343463763114200001L2015634057